Dayer Lindsey E, Breckling Meghan N, Kling Brittanie S, Lakkad Mrinmayee, McDade Elizabeth R, Painter Jacob T
College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas.
J Emerg Med. 2019 Nov;57(5):597-602. doi: 10.1016/j.jemermed.2019.07.016. Epub 2019 Oct 5.
The number of unintentional deaths due to prescription drug overdose has risen in recent years due to the increased utilization of opioid analgesics. Pain is one of the most common reasons for patients to visit an emergency department (ED) and is often treated with opioid analgesics. In 2016, the Centers for Disease Control and Prevention (CDC) released guidelines for primary care providers on prescribing opioids for chronic pain.
The objective of this study was to determine if release of the 2016 CDC guidelines for prescribing opioids for chronic pain was associated with changes in prescribing habits in the ED of an academic medical center.
The data were extracted from patient electronic health records between January 2015 and June 2017. The primary endpoint of the study was average morphine equivalent daily dose (MEDD) for the pre- and postguideline cohorts.
A total of 8652 patients were included in the analysis (4389 in the preguideline cohort and 4263 in the postguideline cohort). The average MEDD decreased significantly from 30.6 ± 20.2 MEDD in the preguideline cohort to 29.8 ± 19.5 MEDD in the postguideline cohort (p = 0.0460). There was also a significant decrease in the rate of concomitant opioid and benzodiazepine prescribing as well as average days' supply per prescription in the postguideline cohort, as compared with the preguideline cohort.
The average MEDD prescribed in the ED of an academic medical center decreased after the release of the CDC guidelines on opioid prescribing for chronic pain.
近年来，由于阿片类镇痛药使用增加，因处方药过量导致的意外死亡人数有所上升。疼痛是患者前往急诊科（ED）就诊的最常见原因之一，且常使用阿片类镇痛药进行治疗。2016年，美国疾病控制与预防中心（CDC）发布了针对初级保健提供者开具慢性疼痛阿片类药物的指南。
本研究的目的是确定2016年CDC慢性疼痛阿片类药物处方指南的发布是否与一所学术医疗中心急诊科的处方习惯变化有关。
数据取自2015年1月至2017年6月患者的电子健康记录。该研究的主要终点是指南发布前后队列的平均每日吗啡当量剂量（MEDD）。
共有8652名患者纳入分析（指南发布前队列4389例，指南发布后队列4263例）。平均MEDD从指南发布前队列的30.6±20.2 MEDD显著降至指南发布后队列的29.8±19.5 MEDD（p = 0.0460）。与指南发布前队列相比，指南发布后队列中同时开具阿片类药物和苯二氮䓬类药物的比例以及每张处方的平均供应天数也显著下降。
CDC发布慢性疼痛阿片类药物处方指南后，一所学术医疗中心急诊科开具的平均MEDD有所下降。
